Publications

ABSTRACT
We present the successful management of a 7-year-
old male child weighing 17.5 kg who presented
with an anterior mediastinal mass and was
scheduled for a tibial biopsy under anaesthesia.
Child had complaints of fever, cough, dyspnoea
and right leg swelling and pain. Upon thorough
evaluation, an MRI of the right knee revealed a
tibial mass measuring 38 x 29 mm, suspected to be
of neoplastic origin. The child required 8L of
oxygen via a face mask to maintain a saturation
level of 98%, while saturation dropped to 88% on
room air. The child was premedicated and sedation
was achieved with Inj. Ketamine 10mg. Face mask
was held using sevoflurane (2-4%), while ensuring
the maintenance of spontaneous ventilation. Under
strict aseptic measures, and a lumbar puncture was
performed with a 23G needle at the L4-L5 level,
following local anaesthetic infiltration.
Subsequently, 1.2 ml of 0.5% hyperbaric
bupivacaine and Inj. Fentanyl 10 mcg were injected
after confirming clear cerebrospinal fluid backflow.
Following spinal anaesthesia, the child was placed
on an oxygen face mask and tibial lesion biopsy
and bone marrow aspiration were successfully
completed. The child remained hemodynamically
stable with spontaneous respiration throughout the
45-minute procedure. Regional anaesthesia for
paediatric patients requires the efforts of an
interprofessional healthcare team that includes the
clinician, anaesthesiologists, and OR nursing staff,
coordinating their activities, and monitoring patient
response to achieve optimal outcomes with
minimal adverse events.
Keywords- paediatric, mediastinal mass, paediatric
spinal anaesthesia